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Elderly in nursing homes have 40% higher risk for antibiotic-resistant UTIs

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December 6, 2018

Céline Pulcini, MD, PhD
Céline Pulcini

Elderly residents of nursing homes had an approximately 40% higher risk for developing antibiotic-resistant Enterobacteriaceae urinary tract infections than peers who lived in the community, according to study findings from France that were published in the Journal of Antimicrobial Chemotherapy.

Céline Pulcini, MD, PhD , a professor of infectious diseases at Nancy University Hospital and the University of Lorraine, and colleagues analyzed 19,471 antibiotic susceptibility tests from urine samples that were culture positive for Escherichia coli (85.4%), Proteus mirabilis (5.7%) and Klebsiella pneumoniae (8.9%) sent to a laboratory in northeastern France. The samples were collected between 2014 and 2017 from individuals aged 65 years or older living in nursing homes or in the community.

After adjusting for patient gender, age and other characteristics, Pulcini and colleagues compared the resistance of E. coli, P. mirabilis and K. pneumoniae isolates to amoxicillin/clavulanate, nitrofurantoin, trimethoprim/sulfamethoxazole, nalidixic acid, ofloxacin, ciprofloxacin and ceftriaxone, as well as possible extended-spectrum beta-lactamase (ESBL) production.

According to the findings, nursing home residents had a higher adjusted odds ratio of Enterobacteriaceae that were resistant to amoxicillin/clavulanate (adjusted OR = 1.38; 95% CI, 1.27-1.50), ciprofloxacin (aOR = 1.33; 95% CI, 1.20-1.49) and ceftriaxone (aOR = 1.37; 95% CI, 1.15-1.63) or produced ESBL (aOR = 1.43; 95% CI, 1.18-1.72) than peers in the community. The nursing home residents and those living in the community did not differ in Enterobacteriaceae resistance to nitrofurantoin or trimethoprim/sulfamethoxazole.

“Elderly people in nursing homes had a risk around 40% higher than their community-dwelling peers of having antibiotic resistant Enterobacteriaceae cultured from their urine samples,” Pulcini and colleagues wrote.

“These results show the importance of implementing antibiotic stewardship programs, as well as infection prevention and control measures and the need for nursing home-specific surveillance that can guide empirical treatment.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

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